Vital Statistics Form

Please fill this form out as much as possible. It will help us to complete the death certificate and in writing the obituary. All fields with an asterisk are required.

Deceased's Information

If residence, please include address
mm/dd/yyyy
English, Irish, French, German, etc.
Be specific
Primary occupation during working years. *Do not enter \"retired\".
Sales, Medical, Engineering, Construction, etc.
Please list survivors and relationship: son, daughter, brother, sister, etc.
Religious affiliations, fraternal and civic organizations, hobbies, etc.

Informant's Information

A copy of what is submitted will be sent to this email.
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Obituaries & Condolences

Randall Lee Deines

Patricia Ann Haefele

Don F. Weaver

Jacquelyn “Jackie” Marie Baker

James (Jimmy) R. Davis

Daniel J. Palermo

Karyn Ann Lindenberger

Michael “Pete” Troxel

Frank R. Ingels

Melvin Eugene Stotts

Leeann Glynette Pratt

Howard Glen Graham